| NPI | 1821192212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX F-25350) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8072) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 38750) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2019-08-08 |